Which antifungal agent for onychomycosis? A pharmacoeconomic analysis

The incidence of fungal nail infections is increasing and this is possibly because of several factors: better methods of detection, a growing populati on of immunocompromised patients who have a greater susceptibility to such infections, the increased use of immunosuppressive drugs, the increasing nu mber of elderly people, worldwide travel, and the use of communal bathing f acilities. Onychomycosis is a fungal infection of the fingernails and toena ils that accounts for about 30% of all superficial fungal infections. It is characterised by nail discoloration, thickening and ultimately destruction of the nail plate. Management of this disease has improved significantly a nd treatment patterns have dramatically changed in recent years as a result of advances in new treatment options (e.g. oral antifungal agents) and cha nges in treatment regimens (e.g. pulse therapy). Also, newer drugs for onyc homycosis have improved tolerability profiles compared with older agents. T he overall costs of treating onychomycosis are substantial, and it has been estimated that direct cost for US Medicare patients with the disease is $U S43 million per year (year of costing not available). Pharmacoeconomic studies help in the decision-making process when selecting the most cost-effective antifungal agents to treat onychomycosis. To date there have been a number of national and international economic studies aim ed at effectively assessing the efficacy and costs of the treatment options available to cure onychomycosis. The objectives of this paper are to (i) r eview the published findings regarding the epidemiology of onychomycosis (i i) summarise the original pharmacoeconomic studies that describe the econom ic impact of the disease; and (iii) address the impact of the disease on pa tients' health-related quality of life.